LEMBAGA HASIL DALAM NEGERI MALAYSIA CP600CPP [Pin.

1/2021]
INLAND REVENUE BOARD OF MALAYSIA
BORANG PENDAFTARAN NOMBOR CUKAI PENDAPATAN PETROLEUM
INCOME TAX NUMBER REGISTRATION FORM FOR PETROLEUM

BAHAGIAN A : / PART A : MAKLUMAT ASAS / BASIC PARTICULARS

A1 Nama orang yang boleh
dikenakan cukai /
Name of chargeable person
A2 Jenis perniagaan utama /
Type of main business
A3 Kod perniagaan utama /
Main business code
A4 Jenis operasi / 1 = Perkongsian 2 = Operasi tunggal
Type of operation 1 = Partnership 2 = Sole Operator
A5 Pengurusan hal-ehwal orang yang boleh dikenakan cukai dilakukan di Malaysia 1 = Ya 2 = Tidak
Affairs of the chargeable person managed in Malaysia 1 = Yes 2 = No
A6a Tarikh mula eksplorasi /
(hh/bb/tttt) / (dd/mm/yyyy)
Exploration start date
A6b Tarikh jualan atau pelupusan
petroleum pertama yang boleh (hh/bb/tttt) / (dd/mm/yyyy)
dikenakan cukai /
Date of the first sale or disposal of
chargeable petroleum
A7a Tarikh mula akaun /
(hh/bb/tttt) / (dd/mm/yyyy)
Opening date of accounts
A7b Tarikh tutup akaun / (hh/bb/tttt) / (dd/mm/yyyy)
Closing date of accounts
A8 Alamat surat-menyurat /
Correspondence address

Poskod / Bandar /
Postcode Town
Negeri
State
A9 Alamat operasi utama /
Address of main operation
(Gunakan alamat SELAIN alamat peti
surat atau karung berkunci /
Use address OTHER THAN P.O. Box or
locked bag address)
Poskod / Bandar /
Postcode Town
Negeri
State
A10 No. telefon / Telephone no.
E-mel operator utama /
A11
Main operator e-mail
MAKLUMAT KONTRAK PERKONGSIAN PENGELUARAN (PSC) /
BAHAGIAN B : / PART B :
PRODUCTION SHARING CONTRACT (PSC) INFORMATION
B1
Jenis Kontrak / 1 = Perjanjian dengan Petronas 2 = Perjanjian dengan MTJA (Malaysia – Thailand Joint Authority)
Contract type 1 = Agreement with Petronas 2 = Agreement with MTJA (Malaysia – Thailand Joint Authority)

B2
Kawasan operasi / 1=Sabah 2 = Sarawak 3 = Semenanjung Malaysia 4 = Lain-lain
Area of operation 1=Sabah 2 = Sarawak 3 = Peninsular Malaysia 4 = Others

B3 No. blok /
Block no.
B4 Status operasi / 1 = Eksplorasi 2 = Produksi
Operation status 1 = Exploration 2 = Production
B5 Tarikh kontrak dimeterai / (hh/bb/tttt) / (dd/mm/yyyy)
Contract signed date
B6 Tarikh kontrak berkuat kuasa / (hh/bb/tttt) / (dd/mm/yyyy)
Contract effective date
B7 Tarikh tamat kontrak / (hh/bb/tttt) / (dd/mm/yyyy)
Contract end date
B8 Tempoh kontrak / tahun / years
Contract period

1
BAHAGIAN C : / PART C : MAKLUMAT PENGARAH / PENGURUS / PARTICULARS OF DIRECTOR / MANAGER

C1 Pengarah / Pengurus I :

C1a Nama / Name

No. kad pengenalan / No. Pasport* Warganegara /
C1b C1c
Identification card no. / Passport No. Citizen
No. telefon / E-mel
C1d C1e
Telephone no. E-mail

C2 Pengarah / Pengurus II :

C2a Nama / Name

No. kad pengenalan / No. Pasport* Warganegara /
C2b C2c
Identification card no. / Passport No. Citizen
No. telefon / E-mel
C2d Telephone no.
C2e E-mail

C3 Pengarah / Pengurus III :

C3a Nama / Name

No. kad pengenalan / No. Pasport* Warganegara /
C3b C3c
Identification card no. / Passport No. Citizen
No. telefon / E-mel
C3d Telephone no.
C3e E-mail

BAHAGIAN D : / PART D : MAKLUMAT PEKONGSI / OPERATOR TUNGGAL / PARTICULARS OF PARTNERS / SOLE OPERATOR
[Gunakan lampiran jika melebihi dua (2) ahli kongsi / Use attachment if more than two (2) partners]
D1 Nama pekongsi 1 / Operator tunggal*
Name of partner 1 / Sole Operator
D1a No. pendaftaran syarikat /
Company registration no.
D1b No. cukai pendapatan / D1c Tarikh masuk perkongsian /
Income tax no. Partnership entry Date
D1d Alamat surat-menyurat /
Correspondence address

Poskod / Bandar /
Postcode Town
Negeri
State
D1e No. telefon / D1f E-mel /
Telephone no. E-mail
D1g Blok bersempadanan / 1 = Ya 2 = Tidak D1h Negara asal /
Contiguous blocks 1 = Yes 2 = No Country of origin
D1i Pegangan syer secara langsung (%) /
Direct shareholding (%)
D1j Nama bank / No. akaun bank /
D1k
Bank name Bank acoount no.
D2 Nama pekongsi II /
Name of partner II
D2a No. pendaftaran syarikat /
Company registration no.
D2b No. cukai pendapatan / D2c Tarikh masuk perkongsian /
Income tax no. Partnership entry Date
D2d Alamat surat-menyurat /
Correspondence address

Poskod / Bandar /
Postcode Town
Negeri
State
D2e No. telefon / D2f E-mel /
Telephone no. E-mail
Blok bersempadanan / 1 = Ya 2 = Tidak Negara asal /
D2g D2h
Contiguous blocks 1 = Yes 2 = No Country of origin
D2i Pegangan syer secara langsung (%) /
Direct shareholding
D2j Nama bank / D2k No. akaun bank /
Bank name Bank acoount no.
(* Potong yang tidak berkenaan / * Delete whichever is not relevant

2
BAHAGIAN E : / PART E : MAKLUMAT FIRMA EJEN CUKAI / PARTICULARS OF TAX AGENT

E1 Nama firma / Name of firm

E2 Alamat firma / Address of firm

Poskod / Bandar /
Postcode Town
Negeri /
State
E3 No. kelulusan ejen cukai /
Tax agent’s approval no.
E4 No. telefon / Telephone no.

E5 E-mel / E-mail

AKUAN PENGARAH / SETIAUSAHA SYARIKAT / EJEN CUKAI /

DECLARATION BY DIRECTOR / COMPANY SECRETARY / TAX AGENT

Saya / I

No. kad pengenalan / Pasport * / Identification card / Passport no.*

(* Potong yang tidak berkenaan / * Delete whichever is not relevant)

dengan ini mengakui bahawa maklumat yang diberikan di dalam borang ini ada lah benar, betul dan lengkap. /
hereby declare that the information given in this form is true, correct and complete.

Tandatangan / Tarikh / (hh/bb/tttt) / (dd/mm/yyyy)

Signature Date

Jawatan /
Designation

SILA KEMUKAKAN : / PLEASE SUBMIT :

a) Salinan Kontrak Perkongsian Pengeluaran (PSC) yang lengkap /Full copy of the Production Sharing Contract (PSC)
b) Salinan Joint Operating Agreement (JOA) dan Joint Operating Company Agreement (JOC) jika berkaitan /
Copy of Joint Operating Agreement (JOA) and Joint Operating Company Agreement (JOC) if any.
Dokumen bagi pekongsi yang belum berdaftar di LHDNM :
Document for partner(s) who have not registered with LHDNM :
1. Syarikat tempatan / i) a) Salinan notis pendaftaran syarikat di bawah seksyen 15 Akta Syarikat 2016 / Copy of notice of
Local company registration of company under section 15 Companies Act 2016
atau / or
b) Salinan perakuan pemerbadanan syarikat di bawah seksyen 17 Akta Syarikat 2016 / Copy of certificate
of incorporation of company under section 17 Companies Act 2016
ii) Salinan dokumen permohonan pendaftaran syarikat di bawah seksyen 14 Akta Syarikat 2016 / Copy of
document of application for registration of a company under section 14 Companies Act 2016
iii) Salinan Profil Syarikat terkini /Copy of current Company Profile
iv) Salinan perlembagaan (jika berkenaan) / Copy of constitution (if relevant)
yang dikeluarkan oleh Suruhanjaya Syarikat Malaysia (SSM) / issued by the Suruhanjaya Syarikat Malaysia (SSM)
2. Syarikat asing / i) Salinan notis pendaftaran syarikat asing di bawah seksyen 562 Akta Syarikat 2016 /
Foreign company Copy of notice of registration of foreign company under section 562 Companies Act 2016

ii) Salinan dokumen perubahan atau pengubahan butir-butir berkaitan syarikat asing di bawah subseksyen
567(1) Akta Syarikat 2016 /
Copy of document of particulars of change or alteration relating to foreign company under subsection 567(1) Companies Act
2016
iii) Salinan Profil Syarikat terkini yang dikeluarkan oleh SSM /Copy of current Company Profile issued by SSM

UNTUK KEGUNAAN PEJABAT

Nama pembayar cukai

Bilangan PSC yang dimiliki oleh orang kena cukai dalam usahasama yang sama
Bilangan PSC dimeterai oleh orang kena cukai dalam tahun semasa
No. cukai pendapatan C
No. PSC